AHIP AHM-540 Online Practice Questions and Exam Preparation

AHIP AHM-540 Online Questions & Answers

• Question 141:

  Among this agency's accreditation programs are accreditation for preferred provider organizations (PPOs), health plan call centers, and case management organizations. This agency classifies its standards as either "shall" standards or "should" standards.

  A. American Accreditation HealthCare Commission/URAC (URAC)
  B. Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
  C. Community Health Accreditation Program (CHAP)
  D. National Committee for Quality Assurance (NCQA)
  A. American Accreditation HealthCare Commission/URAC (URAC)

• Question 142:

  The Glenway Health Plan's pharmacy and therapeutics (PandT) committee conducted pharmacoeconomic research to measure both the clinical outcomes and costs of two new cholesterol-reducing drugs. Results were presented as a ratio showing the cost required to produce a 1 mcg/l decrease in cholesterol levels. The type of pharmacoeconomic research that Glenway conducted in this situation was most likely

  A. cost-effectiveness analysis (CEA)
  B. cost-minimization analysis (CMA)
  C. cost-utility analysis (CUA)
  D. cost of illness analysis (COI)
  A. cost-effectiveness analysis (CEA)

• Question 143:

  Many health plans use HRA to target their preventive care programs to the healthcare needs of their members. With regard to HRA, it is correct to say that

  A. Health plans rarely delegate HRA activities to external entities
  B. Health plans typically focus their HRA efforts on newly enrolled members
  C. HRA focuses on clinical data for an entire population and does not include demographic information that might identify individual members
  D. HRA is generally a reliable predictor of medical resource utilization
  B. Health plans typically focus their HRA efforts on newly enrolled members

• Question 144:

  Demetrius Farrell, age 82, is suffering from a terminal illness and has consulted his health plan about the care options available to him. In order to avoid unwanted, futile interventions, Mr. Farrell signed an advance directive that indicates the types of end-of-life medical treatment he wants to receive. His family is to use this document as a guide should Mr. Farrell become incapacitated.

  The document that Mr. Farrell is using to communicate his end-of-life healthcare wishes to his family is known as a

  A. medical power of attorney
  B. patient assessment and care plan
  C. living will
  D. healthcare proxy
  C. living will

• Question 145:

  The following statements are about health plans' development of medical policies. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

  A. Technology assessment is applicable only to medical policy development for new medical procedures, devices, drugs, and tests.
  B. Technology assessment provides the scientific rationale for the medical policy section that specifies when a medical service is appropriate and when it is not.
  C. The medical policy development process includes both a clinical and an operational review of a proposed medical policy.
  D. The decision to accept or reject a proposed medical policy often depends on how a new technology compares to currently used interventions.
  A. Technology assessment is applicable only to medical policy development for new medical procedures, devices, drugs, and tests.

• Question 146:

  The paragraph below contains two pairs of terms in parentheses. Determine which term in each pair correctly completes the paragraph. Then select the answer choice containing the two terms that you have chosen.

  Health plans use both internal and external standards to assess the quality of the services that they provide. (Internal / External) standards are based on information such as published industry-wide averages or best practices of recognized industry leaders. Health plans primarily rely on (internal / external) standards to evaluate healthcare services.

  A. Internal / internal
  B. Internal / external
  C. External / internal
  D. External / external
  D. External / external

• Question 147:

  In order for a health plan's performance-based quality improvement programs to be effective, the desired outcomes must be A. achievable within a specified timeframe

  B. defined in terms of multiple results
  C. expressed in subjective, qualitative terms
  D. all of the above
  A

• Question 148:

  When conducting performance assessment, a health pln may classify the key processes associated with its services into the following categories: high-risk, high-volume, problem- prone, and high-cost. The following statements are about this classification of processes. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

  A. In some instances, relatively inexpensive processes can qualify as high-cost processes.
  B. Each process must be classified into a single category.
  C. High-risk processes most often involve medical interventions or treatment plans for acute illnesses or case management processes for complex conditions.
  D. Administrative processes such as scheduling appointments are examples of high- volume processes.
  B. Each process must be classified into a single category.

• Question 149:

  The paragraph below contains an incomplete statement. Select the answer choice containing the term that correctly completes the paragraph.

  Medical management programs often require the analysis of many types of data and information. __________________ is an automated process that analyzes variables to help detect patterns and relationships in the data.

  A. Unbundling
  B. Outsourcing
  C. Data mining
  D. Drilling down
  C. Data mining

• Question 150:

  The Westchester Health Plan classifies its key processes into the following categories:

  high-risk, high-volume, problem-prone, and high-cost. Westchester also prioritizes the categories in terms of importance. The process category that Westchester most likely ranks highest in importance is

  A. High-risk processes
  B. High-volume processes
  C. Problem-prone processes
  D. High-cost processes
  A. High-risk processes